Category: Dissemination / Implementation
Keywords: Implementation | Assessment
Presentation Type: Symposium
The introduction of a new practice into community healthcare settings can be challenging. Audit and feedback (AF), or the review of clinical performance data to monitor and adapt provider behaviors, is a promising strategy that may be leveraged to tailor the implementations of evidence-based practices to their intended setting. However, specific examples of procedures which optimize AF are sorely needed. The present study explored a tailored approach to implementing measurement-based care (MBC) in behavioral health clinics and was guided by three aims: 1) delineate AF processes that were used at each clinic during implementation, 2) explore the impact of feedback on tailoring and AF processes, and 3) identify the limitations of AF at each site.
Approximately five providers trained in MBC were selected from each clinic (N=6) to participate in an implementation team which met five times over the course of five months to discuss strategies for implementing MBC. Discussions were based on specialized audit reports that were delivered in advance of each meeting and contained a combination of objective and self-reported MBC fidelity data. The tailored design granted each team the option to add, remove or alter the outputs of each report based on site-specific goals at each meeting. The utilization of audits by each team over time was characterized in a series of individual case studies which reviewed the specific outputs of reports, adjustments made to reporting, tailoring strategies selected in relation to reported data, and limitations to developing reports as requested.
Preliminary results from one clinic revealed that therapist MBC use, client MBC use, and therapist self-reported MBC barriers were included in all reports. In a smaller portion of reports, the team chose to incorporate feedback on individual provider use (4 reports) and use of MBC for all clients receiving services (3 reports). These additions corresponded with the selection of new tailoring strategies by the team such as targeted supervision meetings with individual providers identified as low adopters and collaboration with office staff to ease the burden of data entry. Barriers to audit use included changes applied by administrators to the electronic health record during implementation. These changes limited access to MBC data for undiagnosed clients despite its relevance to goals of clinic-wide use. With advances in technology and increased use of client reported outcomes, AF will become more sophisticated and present critical information that can inform tailored implementations.
Centerstone Research Institute
Sunday, November 19
8:30 AM – 10:00 AM
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